Diet: cranks & quacks - nutrition

National Review, Nov 16, 1984 by William F. Rickenbacker

DIET: CRANKS & QUACKS

NOT LONG AGO I heard a smooth-talking man on the radio discussing the sad state of nutritional education in this country. Of our 127 medical schools, he said, only 15 required their students to take a course in nutrition, and only a few others even offered nutrition as an elective. No wonder, he said, that the field of diet and nutrition is left wide open to cranks and quacks; and it's a tragedy, he said, when two-thirds of all hospital admissions are related to nutritional problems.

Dear me. One nice thing about living on a farm is that you don't have to take that sort of guff lying down. In the time you save by not commuting, you can fire off a questionnaire to all 127 of those medical schools, asking them if they offer course work in nutrition and require such course work for graduation. You can, for comparison, send the same questions to each of the 28 schools of veterinary medicine in this country. So I did.

The response was fine (and uniformly courteous): 83 medical schools (65 per cent) and 21 veterinary-medicine schools (75 per cent). The response was also scandalous, as the radio editorialist had led me to expect: 19 of the veterinary-medicine schools (90 per cent) require students to take courses in nutrition, but only 19 medical schools do (23 per cent). Case dismissed? No.

Almost without exception, the medical schools that reported no "separate' courses in nutrition went on to offer comments describing the nutritional components of courses in biochemistry, pediatrics, obstetrics, internal medicine, physiology, family medicine, geriatrics, community medicine, preventive medicine, and more. The variations are enormous. One school requires a course that contains 18 lecture hours. Another school has no course at all, but calculates that the nutrition components of other courses add up to more than a hundred lecture hours.

Nevertheless, nutritional knowledge is growing fast. Even such an illustrious medical school as Columbia's reports that its separate course work in nutrition has only been "part of our curriculum for about five years.' The University of Arkansas set up a Task Force on Nutritional Education not long ago, which concluded that the subject should be treated more coherently. Its recommendations included:

to develop nutrition as a readily identifiable topic in a) the medical curriculum both as special course offerings and as identified parts of clinical courses, b) an ongoing program of research in nutrition to expand the useful knowledge in this field and to stimulate and reinforce the teaching of nutrition, and c) continuing postgraduate education programs to bring the practicing physician up to date in nutrition.

All to the good.

BUT WOE IS US, here come the Feds. Congress has been fretting about nutritional education; and now the Food and Nutrition Board of the National Research Council Commission on Life Sciences (part of the National Academy of Sciences, which in turn is part of the National Boondoggle) has set up a committee "to examine how and to what extent nutrition is currently incorporated into medical education and to consider ways by which the teaching of nutrition in medical schools can be strengthened' (i.e., they already know what they're going to discover). The report is due in June 1985. Don't hold your breath.

All right, nutrition is important. You are what you eat. And so on. And isn't it scandalous that veterinary-medicine schools teach nutrition more consistently than medical schools?

Scandalous but understandable. Husbandmen can perfectly control what their animals eat; so it is reasonable to study how to exercise that control most efficiently and benignly. Physicians can scarcely control what the average citizen eats; so the emphasis in medical studies is not placed there.

Rather, the nutritional emphasis in medical studies is placed on those areas where the physician does indeed have some strong chance of controlling the diet: pediatrics, obstetrics, geriatrics. The infant can't fight back. The young mother's normal instinct is to do exactly as the physician tells her for the good of the baby. The old geezer has two choices, the less discommodious of which is following the brash young doctor's orders. It makes very good sense to prepare the medical student for these cases. As for the millions of youngsters who are old enough to spend their money (and their health) on lunches consisting of preserved meat on onion rolls, washed down with soda pop--well, the physician will be dealing with them sooner or later, them and their "nutrition-related' disorders.

Last April the president of Harvard, Derek Bok, gave his annual report to his Board of Overseers, and devoted it to the great question of reforming medical-school curricula. Among many points, he urged greater emphasis on "preventive medicine.' Thus:

Up to half of all illness in the United States could be avoided through changes in behavior brought about by voluntary adjustments in lifestyle or by preventive measures on the part of government and private organizations. The latter are primarily the responsibility of the state, acting through appropriate rules and incentives. [My emphasis.]